胫骨结节抬高术对髌股关节生物力学的影响

为客观评价胫骨结节抬高术的生物力学有效性。采用富士压敏片法和染色法测试８具新鲜离休膝关节在行胫骨结节抬高术前后的髌股关节接触部位、面积和应力分布。发现胫骨结节抬高术后,髌骨的习惯性接触区位置向近端移行,这种现象有助于避开对软骨病灶区的挤压和应力集中,对缓解和消除髌股疼痛症状可能有利。因此,提出了“应力集中软骨损伤区导致髌股疼痛”的设想。胫骨结节抬高术后,小屈膝角度（３０°～６０°）有一定的髌股减压作用;但随屈膝角度增加,髌股接触面积减小并出现压力分布不均或局部高压现象。胫骨结节抬高术后,“腱股接触”现象提早（６０°）出现,对髌股关节生物力学行为可能造成影响。

THE EFFECTS OF ANTERIOR TIBIAL TUBERCLE ADVANCEMENT ON THE BIOMECHANICS OF PATELLOFEMORAL JOINT

In order to evaluate the biomechanics effectiveness of Anterior Tibial Tubercle Advancement (ATTA), we measured the contact site, contact area and stress distribution of the patellofemoral joint before and after ATTA procedure in eight fresh human cadaver knee joints with the Fuji Pressure Sensitive Film and the dyeing method. The result shows that the habitual contact site transfer from inferior to superior site after ATTA, which will prevent cartilage lesion site from stress extrusion and concentration, and perhaps reduce or relieve the patellofemoral pains. An assumption of "the patellofemoral pains caused by stress concentration at chondromalacia site" was thus proposed for above finds. after ATTA, the patallofemoral pressure was decreased only in 30°to 60°of knee flexion and became uneven or local high pressure in large degree of knee flexion. The contact area of patellofemoral joint was diminished with the increasing of knee fiexion. The tendofemoral contact appeared advancely at 60°of knee flexion after ATTA, which will affect the biomechanical behavior of patellofemoral joint.